Hde Neeling Institutional review board approval and patient consent were not required because of the review nature of this study. Those frequencies differed according to whether the source for information about cause of death was an autopsy confirmation (49.98%; 95% CI, 43.7556.71) or death certificate (19.65%; 95% CI, 15.4823.83) and according to whether the type of mortality cause was an indirect cause of death (13.96%; 95% CI, 9.4218.51) or direct cause of death (44.45%; 95% CI, 29.8150.10). A study37 of the BANS-S suggests that more than 90% of these patients would have a score of 0 on the Mini-Mental State Examination. Brown The time for their recovery (median, 9.5 days) was not significantly different from the recovery time of the AB-curative patients (median, 10 days). L Several infections have been suggested to increase risk of Alzheimer's disease, but the evidence behind it is not clear cut. TEChristmas Information from the literature concerning the frequency of withholding antibiotics is limited. Some older people need to get more than one pneumonia vaccine. Pneumonia-associated death in patients with dementia: A - PubMed Cumulative meta-analysis using a random effects model for frequency of pneumonia-associated death is shown, by study. JPlewis Accessibility Statement, Our website uses cookies to enhance your experience. WGGoossens However, dementia covers a wide range of symptoms and encompasses a group of related neurodegenerative disorders. TJDurant Dying From Dementia With Late-Stage Symptoms - Verywell Health The death of your loved one can be a hard concept to wrap your head around and accept. Our results indicated that clinicians must pay careful attention in cases of pneumonia among patients with dementia in the terminal stages of illness, to maximize patients life expectancy and quality. CAAdr Twelve AB-withheld patients survived. Moreno RSSiu Brauner Once it has been weakened, bacteria, viruses, and other harmful substances can get through into the brain more easily. Squares represent 95% confidence intervals (CIs). Confidentiality of data was guaranteed by physicians providing coded information to the researchers (as opposed to patient or physician names). GH However, the reported frequency of pneumonia as a cause of death in patients with dementia varies, the reason for which has not been fully elucidated. Charlson KE. Conclusions: Pneumonia in patients with dementia involved elevated levels of suffering during 10 days following diagnosis and in the days preceding death. Although comorbid conditions among patients in the present study could not be examined, our results suggest that pneumonia has a strong and direct impact on mortality in older adults with dementia, regardless of whether they have other, possibly fatal underlying conditions. using a guideline for decision-making. There was also the possibility of different criteria used to determine pneumonia as the cause of death among studies. To our knowledge, this is the first large quantitative study in which predictors of withholding antibiotic treatment in daily practice are assessed. As the nature of disease among study participants as well as the nature of meta-analysis precludes the use of individual patient data, the heterogeneity among patients in each study could not be determined. It is available to read online or download to print at home, or you can order a copy through the post. Here are Tips for Defeating Acid Reflux, Heartburn Naturally, Dry Drowning Warning Signs That Parents Should Know. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia. Dementia | Sepsis Alliance Patients with pneumonia (N = 706) were enrolled in nursing home units for patients with dementia from all over the Netherlands (61 nursing homes). This is because there is some research to show Alzheimer's is more common in people who have these infections. Advance Directives It used to be standard to give antibiotics to people with late-stage dementia because the disease makes infectionssuch as pneumonia more common. Cognitive impairment is common in HF syndromes with estimates of its prevalence varying between 25% and 75%. Conclusions Table 3 describes the characteristics of the treatments used in the patients who were treated promptly. All statistical tests were performed using Review Manager (RevMan) ver. MRLipsitz Here are five things you can do to help lower your chances of developing dementia, with illustrations by multi-award winning cartoonist Tony Husband. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia. The physicians completed questionnaires about the patients at the time of the treatment decision that described the patient's current condition (baseline) and their condition 2 weeks earlier (variables recorded are displayed in Table 1 and Table 2). WJStobberingh Trouble swallowing increases the risk of choking. We suspect that similar factors would generally reflect current physicians' attitudes in industrialized countries. One of the ways dementia disorders affect the body is that they destroy the ability to swallow safely. Compared with the patients who received antibiotics with curative intent, patients in whom antibiotic treatment was withheld had more severe dementia, had more severe pneumonia, had lower food and fluid intake, and were more often dehydrated. Illness severity by clinical judgment seemed to be the strongest independent predictor of withholding antibiotic treatment. et al. Throughout the meta-analysis, we calculated the prevalence of pneumonia-associated death or ORs with 95% confidence interval (CIs) using a random effects model, generic inverse variance method. The most significant item of the BANS-S for severity of dementia with respect to withholding antibiotic treatment proved to be eating dependency 2 weeks before the treatment decision. If left untreated, complications can be serious, even fatal. In patients treated with antibiotics, treatment to relieve symptoms was started in only a few cases. The important physical changes associated with aging include decreases in the elastic recoil of the lungs, compliance of the chest wall, and strength of the respiratory muscles [24]. Ribbe JG Fried Pneumonia is a bacterial, viral, or fungal infection that causes inflammation of the . Antibiotic treatment was also often withheld in patients with dehydration and insufficient drinking. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the statement by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group [14, 15]. You're bound to be worried if a loved one with dementia develops a respiratory infection such as pneumonia. KCarpenter Funding: This study was supported by the Japan Society for the Promotion of Science (JSP) grant KAKENHI26293115 (Koichiro Kudo). In addition, withholding antibiotics occurred more often in the summer and in patients with an initial episode of pneumonia. The frequency of pneumonia-associated death among 19 eligible studies was 29.69% (95% confidence interval [CI], 25.8633.53). Customize your JAMA Network experience by selecting one or more topics from the list below. At the moment, there is not enough evidence to know whether treating infections would be a good strategy to treat Alzheimer's or to reduce the risk of the condition. However, lack of variation with respect to a variable is indirect evidence that it is not weighted significantly in decision making. Physicians and families face choices about whether to withhold antibiotics when patients are expected to die soon or when treatment may be burdensome. Owing to limited data availability for the present meta-analysis, the most common form of dementia among the included patients was AD (Table 1). J-NBerg And food or liquids can enter the lungs, known as aspiration. TikTok video from Michelle Nichols (@mifmeister22): "#nannatiktok #dementia #96yrsold #warrior #pneumonia #fyp #thankyou #nhs #calderdaleroyalhospital". No, many older adults live their entire lives without developing dementia. In AB-withheld patients, symptom relief in general and opiates specifically were instituted more often than in AB-curative patients (P<.001). M. van Eijk, PhD, C. M. P. M. Hertogh, MD, PhD, G. J. Ligthart, MD, PhD, M. T. Muller, PhD, and G. L. Schut, MD, PhD. Patients with dementia in the terminal stages urgently require careful clinical management of pneumonia, to maximize patient life expectancy and quality. Among all eligible studies including patients with dementia, the frequency of pneumonia as a cause of death was approximately 20% in studies using death certificates (Fig 3C); however, this frequency was approximately 50% in studies using autopsy reports in hospital settings (Fig 3B). Arch Intern Med. ACVolicer et al. et al. Attitudes toward withholding antibiotics from people with dementia Cumulative meta-analysis using a random effects model for frequency of pneumonia-associated death is shown, by study. MESax Demographic data on the physicians and the facility characteristics were obtained during site visits by one of the authors (J.T.v.d.S.). Most cases of dementia, up to 70%, are caused by Alzheimer's disease. CBanerjee 2023 American Medical Association. Stratified subgroup analysis was conducted among studies grouped according to type of mortality cause (immediate or underlying), information source of mortality cause (autopsy or death certificate), and study setting (clinic, hospital, or nursing home). Nostril widening during each breath. Facilities varied negligibly in withholding antibiotic treatment (variation on nursing home level in multilevel analyses). Aspiration pneumonia in old patients with dementia. Prognostic factors Dementia is not a specific disease. Studies fulfilling the following selection criteria were included in the meta-analysis: (1) study design and language: randomized controlled trials, cohort studies, cross-sectional studies, and case series in English language; (2) population: adult patients with dementia or without dementia (as control patients); (3) primary outcome variables: the distributions of pneumonia-associated death. We did not specify this, but the physicians may have feared these patients would be cured of the pneumonia at the cost of a decreased general condition. Volicer They form a starting point for the conceptualizing of guidelines. The younger pneumonia patients actually had higher scores of discomfort at the time of the treatment decision, had more severe dementia, and were more severely ill at the time of and before the treatment decision. The occurrence of a pneumonia may have been used as an opportunity to let the patient die a natural death. MWEthical aspects of medical decision-making in demented patients: a report from the Netherlands. Updated on October 26, 2022 Medically reviewed by Brigid Dwyer, MD Knowing what to expect can help when your loved one has late-stage dementia. BColombo Its presence in the brain could cause inflammation , which could contribute to the underlying Alzheimer's disease mechanism. Two authors independently determined the suitability of studies and potential bias and extracted the data. More people now than ever are over 65 and that will continue to grow for several years before we start to see a decline , said Dr. Barrera. YLLasch In previous meta-analyses, the underlying cause of death was defined as the disease, injury, or corresponding circumstance that initiated the chain of events (i.e., the intermediate cause of death) ultimately leading to death (7, 8, 9). LEffect of fever-management strategy on the progression of dementia of the Alzheimer type. Data Availability: All relevant data are within the paper and its Supporting Information files. BSaludades Furthermore, to promote openness and responsible decision making, it is helpful to have an ethical and legal framework for decision making on whether to withhold antibiotic treatment.17,27 Having a practical guideline including all these aspects is useful when discussing antibiotic treatment options with the patient's family and also in advanced care planning. Cumulative meta-analysis using a random effects model with odds ratios (ORs) shown by study. What kind of information would you like to read? BJThe meaning and use of the area under a receiver operating characteristic (ROC) curve. Copyright: 2019 Manabe et al. The values of the other 5 predictors in the multilevel model of Table 5 seemed almost equally important among individual physicians when deciding to withhold antibiotic treatment. Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, Saitama, Japan, Previous studies have revealed an association between respiratory function and cognition, which is impaired in dementia [3133]. WHTreatment decisions for infections occurring in nursing home residents. However, the reported frequency of pneumonia-associated death varies among patients with dementia [613]. Its a tragic and well known fact that elderly patients can experience dementia, or an acute mental status change, as a symptom of aging or a disease, such as Alzheimers. MWPneumonia: the demented patient's best friend? Dysautonomia after COVID: Is there a connection? - Medical News Today Now, however, some doctors may recommend against antibiotics, believing the risks outweigh the benefits. Evidence suggests that inflammation, the Alzheimer's hallmark amyloid protein and the ApoE4 gene, which are all linked to Alzheimer's disease, can contribute to the breakdown of the blood-brain barrier. Background Many of these cases are unique because often no other obvious symptoms are present, said Carlos Barrera, M.D., whose specialties include internal medicine and pulmonary medicine. LCollard Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. LEffect of antibiotic treatment on outcome of fevers in institutionalized Alzheimer patients. Therefore, we hypothesized that the frequency of pneumonia-associated death differ depending on the methods used to obtain information about the cause of death (autopsy or death certificate), types of mortality cause (immediate or underlying cause), study settings, and the subtypes of dementia investigated. Diamonds at the bottom of the figure show 95% CI range of the overall estimates. We used the following key words: (dementia OR Alzheimers dementia OR Alzheimers disease OR Alzheimer disease OR dementia with Lewy bodies OR diffuse Lewy body disease OR vascular dementia OR frontotemporal dementia OR mixed-type of dementia) AND (pneumonia OR lower respiratory tract infection OR bronchopneumonia OR aspiration pneumonia OR nosocomial pneumonia OR community-acquired pneumonia OR hospital-acquired pneumonia OR nursing and healthcare-associated pneumonia OR ventilator-associated pneumonia) AND (mortality OR death OR comorbidity). In addition, emphysema, asthma, cystic fibrosis . However, there are other illnesses or conditions that cause dementia. Likewise, of pneumonia symptoms, decreased alertness was more important than Cheyne-Stokes respiration, tachypnea, coughing, respiratory distress, fever, malaise, and abnormal chest auscultation. MJSmith We also reviewed the reference lists of eligible studies using Google Scholar and performed a manual search to ensure that all appropriate studies were included. (b) Data from 12 studies using death certificates. This finding suggests that withholding antibiotic treatment was not merely because of, for example, problems with oral intake. Characteristics of patients, physicians, and facilities were related to the outcome of withholding antibiotic treatment. The present meta-analysis was limited to the evaluation of published data. However, considerable variation occurred in how patient age, aspiration, and history of pneumonia were related to decision making by individual physicians. Our results indicated the risk of pneumonia-associated death was increased more than twofold in patients with dementia (OR, 2.15) (Fig 6). Older adults with dementia in particular are more likely to die from pneumonia than those without dementia [69, 11]. Detailed search strategy (Pubmed). Hoogendoorn Characteristics of facilities and physicians were unrelated to the decision. Given that theimmune system is thought to be a key factor in the development of the condition, further research is needed to shed more light on this important topic. What can increase a person's risk of dementia? What type of dementia could be a result of pneumonia?Dementia generally refers to a decline in mental ability that is serious enough to interfere with daily life. Management of pneumonia in advanced dementia may exhibit considerable variation in treatment internationally. (a) Data from 7 studies using autopsy reports. Goettsch Background Pneumonia is a serious disease associated with mortality among patients with dementia.
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